BCIT Environmental Public Health Journal
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Knowledge translation and the Public Health Inspector: turning evidence into practice
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Background: Knowledge translation (KT) is the process of using the best available knowledge to inform decision-making. Public Health Inspectors (PHIs) are tasked with the critical responsibility of protecting public health. However, there is little data available about how effective and consistent current methods of distributing information to professionals across Canada are. The efficacy of KT has implications on the PHI profession and ultimately, public health protection. Objective: The purpose of this research is to identify how PHIs across Canada take evidence and incorporate it into practice. Methods: A survey was created with questions focused on determining what information PHIs use when making public health decisions, how PHIs go about finding the information required, and the level of trust invested into each source of data. Questions were formulated with guidance from the National Collaborating Centre of Environmental Health (NCCEH). It was distributed electronically to PHIs via social media and BCIT. Results: PHIs use evidence-based information to advise their decisions and actions always (43%) or often (46%) in daily practice. Government agencies, professional organizations, peer-reviewed literature, and colleagues are most often used and deemed as reliable resources. Although very frequently used, the internet was seen as neither reliable nor unreliable. 77% of respondents cited that barriers exist that impede their access to evidence-based information. The most common barriers listed were time constraints, costs, and lack of relevant information. Conclusions: The internet is becoming an increasingly popular means by which knowledge is delivered. However, web-based public health resources need to be more concise, easily accessible, PHI-specific and facilitated by reliable entities to effectively address barriers to practice. Increased communication of evidence, practices, and standards are required between health authorities, government agencies, and PHI professionals to ensure consistent and cohesive protection of public health.
 
Assessment of sous vide knowledge and inspection/cooking practices
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Background: In September 2014, BCCDC developed “Guidelines for Restaurant Sous Vide Cooking Safety in British Columbia” providing Environmental Health Officers (EHO) and sous vide cooking chefs safety knowledge about sous vide cooking. To assess whether the guidelines improved sous vide safety knowledge, a study was conducted to examine and compare knowledge differences between EHOs and chefs who had read the guidelines to those who had not read the guidelines. Methods: An online survey was created and advertised by publishing on the BCCDC website, in newsletters and magazines (Vancouver Costal Health newsletter, Fraser Health news Letter, Chefs Quarterly magazine), and through e-mail distribution lists to EHOs and chefs, including chefs at Vancouver Community College. The questions in this survey were developed based on the guide-lines. T-tests and Chi square analyses were conducted to assess knowledge difference between those who read the guidelines and those who did not. Results: A total of 65 people completed the survey, including 45 EHOs (69.3%), 15 chefs (23%), and 5 others (7.7%). EHOs who read the guidelines had significantly higher average knowledge scores in the multiple choice section of the sous vide safety knowledge survey (p=0.00028, t-test) when compared to EHOs who had never read the guidelines. No differences were found in the true and false section (p=0.43925, t-test). With regard to inspection practices, EHO who read the guide-lines were more likely to frequently check for the internal temperature of sous vide foods, water bath temperature, time/temperature in the recipes, calibration of thermometer and proper labels on sous vide pouched foods than EHOs who never read the guidelines. Chefs who read the guidelines had similar average score as chefs who never read the guidelines in T/F (p=0.79878, t-test) and multiple choice (p=0.97, t-test). With regard to cooking practice, chefs who read the guidelines were more likely to frequently calibrate thermometers than chefs who never read the guidelines. However, chefs who never read the guidelines were more likely to frequently find their sous vide pouch floating dur-ing the cooking process, to check for internal temperature of sous vide food, and to label their sous vide pouch properly. Conclusion: These results show that EHOs who have read the sous vide guidelines have better sous vide knowledge in comparison to EHOs who have never read the guidelines. They are also more likely to have overall better inspection practices. Nevertheless, results show chefs who read the guidelines have similar sous vide knowledge in comparison to chefs who never read the guidelines. In terms of cooking practices, these chefs are likely to have better cooking practices only in certain areas.
 
Dinesafe Toronto: an evaluation of the placard system
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Background: The purpose of this research study was to analyse the success of Toronto’s placard system (Dinesafe) in reducing the number of violations in food service establishments. The placard system is designed to inform the public about restaurant inspection results and to boost operator compliance. Inspections are a point-in-time check of the facility’s ability to manage the risk it poses to public health. It is accepted that if best practices are implemented as designed by an establishment’s food safety and sanitation plan, the risk of a foodborne illness/outbreak can be minimized. Methods: From the Dinesafe program, the number of violations cited at each inspection from all relevant food service establishments receiving a conditional pass from two time periods, 2004-2006 (Before) and 2012-2014 (After), were compared to see if there was a decrease in violations. The reports, completed by Public Health Inspectors (PHI), were retrieved from a publicly available website. Data were analysed using a two-sample T-test. Results: The anticipated decrease in violations in the second time frame was not significant [p = 0.85] nor strong (α = 0.001). The means were similar (3.83 Before and 3.71 After), with standard deviations of 1.91 and 1.79 respectively. A greater number of restaurants were cited in the After analysis (3169 compared to 572). Inspections from 2004-2006 had fewer violations (12 or less) than 2012-1014 (14 or less). The majority of violations (71% Before and 73% After) were between 2 and 4. Reoffenders comprised of 16.3% of total violations in 2004-2006 and 17.5% in 2012-2014. Conclusion: There is no evidence that the placard system has decreased violations or that counting the number of violations a good measure for compliance. Pushback among operators could explain the increase in the number of establishments cited. The increase in maximum citation could be due to an increase in citations available from 2012-2014. The number of establishments that received a conditional pass twice in a time frame increased from 59% to 68%. The maximum number of times an establishment received a conditional pass dropped from 10 to 8. It is recommended that Health Units use plain language narrative on the website rather than violations as a measure to communicate findings to the public. The placard significance should be better communicated to the public.
 
Consumers knowledge regarding pesticides on apples and effective washing to remove the pesticides
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Objectives: With the increased health awareness, there is a growing demand of fresh produce in food. Not only is there a possibility of the fresh produce to be contaminated with harmful micro-organisms, but also chemicals such as pesticides that have harmful adverse effects. The effective method of washing the fruit can reduce the level of pesticide residue to a significant amount. The objective of the study is to determine if the general public is aware of washing the produce properly and if knowledge, age, gender, education or concerns have any association with the effectiveness of washing. Methods: The study was done using a survey that was designed using Google Forms. An online survey which was self-administered was sent out using snowball sampling. The survey was publicized through both email and social media Facebook. The survey had 19 questions in total 11 of which were general and 8 were knowledge based. The results were analysed by Chi-square test using NCSS Software Package. Results: It was found that there is a statistically significant association between knowledge level and effective method of washing the apples with a p-value of 0.00082. This means H0 is rejected; hence it means there is an associative between knowledge level and effectively washing the apples. No other demographic factors (age, gender, education, concerns, or having children) were found to be associated with the method of washing the produce effectively. Conclusion: It was found through the study that the people who were aware and had good knowledge about the presence of chemicals (pesticides) on apples would wash their fruit (apples) effectively enough that will reduce the pesticide residue on fruits more than people who aren’t aware of the pesticides on fruits. Other factors such as age, gender, preference for the type of food were not found to have any association with washing of the fruit effectively or higher level of knowledge.
 
Effectiveness of mechanically tenderized beef labels on influencing practices of cooking beef in British Columbia
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Background: Mechanically tenderized beef poses a higher risk for Escherichia coli 0157:H7 infection than intact beef and has been implicated in several outbreaks. As such, all products are mandated to be labeled in Canada. Purpose: This study assessed the effectiveness of mechanically tenderized beef labels on influencing practices of cooking beef in British Columbia. Methods: 74 adults within British Columbia who cooked beef were surveyed electronically using a snowball method. An inferential (Pearson chi-square analysis) and descriptive analysis was performed on the nominal data in PSPP and Microsoft Excel respectively. Results: Only 8% of respondents abided with information on mechanically tenderized beef labels. No statistically significant associations were found between practices of abiding with information on mechanically tenderized beef labels and various socio-demographic factors (e.g. age, gender, education level, and food safety education) (p<0.01). The practice of not using food thermometers was the major contributing factor that lowered the effectiveness of mechanically tenderized beef labels. Conclusion: Mechanically tenderized beef labels were ineffective in influencing behaviours of cooking beef in British Columbia. Therefore, other risk communication strategies are needed to persuade adults in British Columbia to adequately cook mechanically tenderized beef products. Recommendations: Future studies can assess whether the general public is properly cooling mechanically tenderized beef as the label does not address this practice.
 
Inspection violations and community care facilities in British Columbia, Canada
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Background: In British Columbia, community care facility is a broad term that covers many different type of facilities including residential care and child care facilities. These facilities are inspected and audited by the BC regional health authorities to ensure that they are operating in compliance with the BC Community Care and Facilities Act and its respective regulations. These facilities house population groups that are at higher risk of injury or illness due to their physiology and behaviour. Therefore, it is crucial that these facilities are operating in compliance with the prescribed legislation to minimize the risk of illness and injury to the users of these facilities. Objective: The purpose of this study was to determine if there were any differences in the number of violations in residential care and child care facilities between the different health authorities in BC. Methods: Inspection data were randomly selected and extracted from each of BC’s five health authority’s websites and assessed for the number of violations found in these inspections. Violations were tallied and an ANOVA analysis was performed to identify if there were any differences in the number of violations between the health authority regions. Results: Statistical analysis was performed using Microsoft Excel 2013 and NCSS. There was a statistically significant difference of violations between child care and residential care facilities located in the Interior Health Authority region and Northern Health Authority region. Interior Health Authority child care and residential care facilities have more violations than Northern Health Authority child care and residential care facilities. Conclusion: Violations in child care and residential care facilities varied among the five BC HA region. The IHA facilities were found to have the overall highest number of violations for both child care and residential care facilities whereas the NHA facilities were found to have the lowest number of violations. This suggests that patrons of child/residential care facilities in IHA have a higher potential of getting injured or ill compared to patrons in facilities located in NHA.
 
Pesticide residues in organic apples: determining the amounts of thiabendazole, diphenylamine, and myclobutanil in organic apples
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Objectives: The popularity of organic diets continues to increase even without sound evidence that these diets are healthier than conventional diets. As its popularity increases, organic foods become more readily available and accessible to the public, and genuinity comes into question as farmers and retailers find ways to profit from this trend. Although organic produce will never be completely free of pesticides, they are expected to have considerably lower amounts. In recent years, pesticide residues in organic apples have been found to be at levels higher than normal background levels, indicating intentional application by farmers. Thiabendazole, diphenylamine, and myclobutanil are some of the more common synthetic pesticides that have been found in organic apples; therefore, the following study tested whether or not the levels of thiabendazole, diphenylamine, and myclobutanil in organic apples were below the acceptable organic standards of 5% of their respective Maximum Residue Limits (MRLs). Methods: A modified QuEChERS method involving juicing and extraction was used to recover pesticides from the organic apples. Two additional samples were spiked with 1 ppm of each pesticide as controls to determine if the method was able to detect the pesticides. One sample was spiked before the juicing step, and the other sample was spiked after the juicing step. Samples were then analyzed using gas chromatography. Results: Thiabendazole, diphenylamine, and myclobutanil were not detected in all 30 organic apple samples. Furthermore, these pesticides were only detected in the one of the spiked samples – the sample which was spiked after it was juiced. Conclusion: Organic apples grown in BC meet the organic standard of containing pesticide residue levels below 5% of the MRL, at least for thiabendazole, diphenylamine, and myclobutanil. However, since pesticides were not detected in the sample which was spiked before juicing, the methodology of this study may require modification. One possible reason for this finding is that pesticides may be concentrated in the pulp that is separated during juicing, therefore suggesting that juicing apples may be a good practice for reducing the consumption of pesticides.
 
Vancouver community gardeners perceptions on soil health and contamination
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Background: Reclaiming and converting brownfields into green spaces, such as community gardens, is a growing trend especially in Vancouver, British Columbia. Although community gardens provide a wide amount of benefits: health, social, and environmental, there are potential risks when growing and eating food from contaminated soil. Gardeners must take the proper precautions to reduce their exposure to such contaminants such as having their soil tested. Methods: The researcher gathered information via an online survey from 23 community gardens in Vancouver, British Columbia. Survey participants were asked questions regarding garden site history, soil contamination and overall gardening knowledge. Results: A total of 101 community gardeners participated in the study. The typical survey respondent was female, 30-49 years old, had less than 10 years of gardening experience with Bachelor degrees. It was found that no association exists between having soil testing and the location of the garden, park vs. non-park (p = 0.89712). Again, there is no association between the location of the community garden and gardeners’ feelings that their soil is safe and contaminant-free (p= 0.39521). Conclusion: Gardening in soil that has previously been contaminated through industrial processes poses a potential health concern. Despite this concern, community gardeners refrained from soil testing and remain confident in the safety of their garden’s soil. The absence of soil testing indicates a gap in the safety standards for community gardens. Therefore, mandatory and annual soil testing should be implemented with Vancouver’s community gardens to ensure the health and safety of gardeners.
 
Contrasting the effectiveness of chloramines reduction in indoor swimming pools disinfected by ozone versus UV
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Objectives: Chloramines are disinfection by-products that are produced between chlorine and contaminants in the pool. Exposures to chloramines at high levels or for extended durations have been found to cause mucous membrane irritations and respiratory distress in humans. To reduce chloramines production, secondary treatment in the form of UV and ozone are used in newer indoor swimming pools. This study aimed to examine whether there is a difference between UV and ozone treatment in their effectiveness in reducing chloramines in indoor pools. Killarney leisure pool and whirlpool, which utilized ozone treatment, as well as Hillcrest leisure pool and whirlpool, which utilized UV treatment, were studied. Methods: Hach Pocket Colorimeter 2 Analysis System which used a DPD method of analysis was used to determine concentrations of free chlorine and total chlorines. Concentrations of chloramines were calculated by subtracting the concentration of free chlorine from total chlorine. Thirty pool water samples for each type of pool system were analyzed on random days in the afternoons of January and February, 2015. A two sample t-test was used to compare the chloramines concentrations of the whirlpools; while a Mann-Whitney U test was used to compare the chloramines concentrations of the leisure pools. Results: There was a statistically significant difference between the mean chloramines concentration of the UV-treated whirlpool and that of the ozone-treated whirlpool (p = 0.00854). However, there was not a statistically significant difference between the mean chloramines concentration between the UV treated leisure pool and that of the ozone treated leisure pool (p = 0.882048). Conclusions: It was determined that UV was more effective than ozone in reducing chloramines concentrations in indoor public whirlpools. Therefore, in order to choose a treatment that leads to the greatest reduction of health hazard posed to pool patrons, UV is preferred. Whirlpools that intend to adopt secondary treatment may consider UV.
 
Increased organic contamination found on mobile phones after touching it while using the toilet
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Background: Mobile phones are considered as an indispensable handheld item in society today. Frequently used, these devices are a “high-touched” commodity. Previous research has demonstrated that E. coli and other environmental contamination are responsible for the contamination of mobile phones. This study will measure the level of contamination (or sanitation) of mobile phones at an educational institution. Method: The Hygiena MicroSnap Coliform and E. coli Enrichment Swab and the Coliform and E. coli Detection Swabs were used to detect the presence (or absence) of E. coli and total coliforms on subjects’ mobile phones. The Hygiena UltraSnap ATP Surface Test was used to detect levels of ATP. The SystemSURE Plus Luminometer generated readings in RLUs that determined the level of sanitation. In addition, each subject answered two questions regarding their gender and whether or not they have touched their phones while using the toilet within the past week. Results: No presence of E. coli or total coliforms were detected (0 RLUs). A one-tailed paired T-test confirmed that the ATP levels sampled from participants that touched their phones while using the toilet within the past week was statistically significant (P=0.008390). A two-tailed paired T-test confirmed that ATP levels was not statistically significantly different between males and females. Conclusions: Based on the results, touching mobile phones while using the toilet contributes to increased ATP levels found on mobile phones. There were no differences in ATP levels found between males and females. Future studies are required to confirm this.